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General NPI Number Information
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NPI Number | 1871461277
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Entity Type | Individual
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Provider Name | ANGELA WILSON
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1725 W 12TH ST
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City | BROOKLYN
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State | NY
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Zip | 11223-1145
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Country | US
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Telephone | 646-844-0409
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Fax | 646-838-4447
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Provider Business Mailing Address
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Address Line | 770 ROCKWELL LN
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City | DES PLAINES
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State | IL
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Zip | 60016-6218
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Country | US
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Telephone | 347-707-3959
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Fax | 877-599-1211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 614251
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License Number State | NY
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